Hello all, I am looking for someone with a good knowledge of

Resolved Question:

Hello all, I am looking for someone with a good knowledge of medications as well as overall mental health. Lately I have been having bad anxiety/slight depression in the mornings. I am up at 6am and have to be at work monday-friday 8-5pm. I have never been good in the morning and I want some advice on how to be more positive. Currently I take paxil 20mg, I was on Lorazapam but have been off it for 1 month. I have also been taking Tylenol with codeine #4 one a morning. It seems to lift my mood but I have this feeling after it wears off it makes me the opposite. I do alot on my mind. My current job is very dull and boring. I have an upcoming interview for a great position, and don't want my negative mood affecting my chances of getting the job. I bumped up my paxil to 30mg and take it 2am. Normally I would take it right before bed 10pm. I'm wondering if taking it at different times might help me. I've been on paxil for 12 years. I don't want to go back on Lorazapam but it seems to work best. I see a social worker and talking helps a lot, but I want to more advice regarding medications and alternative ways to elevate my mood. Please provide good details thanks.

I am so sorry that you are having these issues with anxiety and depression, I can imagine how distressing this must be for you

Dr. Z :

I would like to ask a couple questions to get some more information, so that I can better assist you

Customer:

I have a big job offer that i cant get my mind off and don't want my "overthinking" make me blow it

Customer:

yes ask anything i want you to have all the facts

Dr. Z :

So currently your major issue is with anxiety and "overthinking"

Dr. Z :

Also when your went off the Lorazepam, what dosage was this at and did you wean off the medication slowly?

Customer:

yes, my LCSW says I think more than i should but nothing too out of the ordinary

Customer:

.25mg twice a day

Dr. Z :

And did you stop Lorazepam abruptly or did you wean off of it?

Customer:

i went to once day before bed for 3 weeks, then stopped completely

Dr. Z :

Okay that is fine then, most likely you did not suffer any withdrawal effects

Customer:

I had my bloodwork done 2 weeks ago my testosterone was very low, now i am on Testosterone for the past 2 weeks

Dr. Z :

Since you took the Paxil for so long your body may have adapted to it and this is why it may not be as effective for you

Customer:

well lets start with the paxil, is there a better time to take it to help me with my rough mornings?

Dr. Z :

Since you get up at 6AM, I think taking the Paxil as soon as you get up should help you for your mornings. Paxil usually has a halflife around 3-60 hours, so this will be very effective for you in the morning.

Dr. Z :

Also if you take it too late at night, it may keep you up and not allow you to sleep effectively, which can raise your anxiety too

Dr. Z :

But if the Paxil is no longer effective for you, then no matter what time you take it at it will not improve your mood unfortunately

Customer:

thats the million dollar question knowing if it still works for me, i know when i try to get off it, i get bad headaches

Dr. Z :

You can help jumpstart your Paxil to be more effective though if you take a low dose of Abilify or Remeron with it and may be able to improve the effectiveness of the Paxil

Dr. Z :

Well with any SSRI medication you either have to switch to another Serotonin dominant medication like Lexapro, Effexor, Cymbalta, Zoloft, ect...or wean off the medication slowly to avoid those withdrawal effects.

Customer:

so you said the half life is 3-60 hours or 3-6 hours?

Dr. Z :

I think since you like the Paxil and are hesitant to try another medication at this time, taking a low dose of Abilify may be the safest option for you

Dr. Z :

The average is 24 hours, but it can range from 3-60 or 65 hours

Customer:

well im hesistant on taking a new medication, this job i might get will drug test me and I don't want a medication to raise a red flag and prevent me from getting the job

Dr. Z :

Well the Abilify would just be an add-on to your Paxil and it does not show up on drug tests unless you are specifically looking for it. Also another option for you is that you can take Gabapentin at night. It is also a hypnotic and has sedative properties to help with anxiety and also will not show up on a drug test unless you are specifically looking for it. Also it is not addictive like a benzodiazepine.

Customer:

what about my medical records can they find out or am i protected by hippa/ada laws?

Dr. Z :

Most employers cannot look at your medical records, it is protected by HIPPA. But if you are working in Law Enforcement or for National Security interests, then you may be required to divulge that information in your medical records.

Customer:

the position is law enforcement, I have spoken to my doctor and a lawyer and they stated to me there is no special waiver they can make me sign in order to obtain this information or psychiatric records. The doctor told me he treats police officers on SSRI's and they still have there job...

Dr. Z :

That is good, but they may compel you to take their own mental health evaluation. I personally do mental health evaluations for new cadets and officers on a regular basis as part of my practice. But I think you are safe, they cannot legally look into your medical record, but they may ask you about any medications you are using, this is standard practice, and you can tell them or not, that is your legal right.

Customer:

I mean id get off the paxil if it would really get in the way, but ive been on it so long and its never affected me in a bad way, in all honestly it helps me last longer sexually

Dr. Z :

That is very good, and I am glad that it is helping you. I think trying to add Abilify may help jumpstart your Paxil again to help it be more effective for your anxiety

Customer:

well if it my legal right not to disclose that, and they cannot find out, perhaps id consider trying abilify, but I really don't want to jump on anything new if its going to ruin my chances

Dr. Z :

I understand. The gabapentin is used off-label for anxiety, so that is probably a safer medication to try for yourself then

Customer:

since you do evaluations for new officers, does Paxil raise a red flag in your eyes?

Dr. Z :

No, not all. For most new officers a use of antidepressant is not a red flag, but it is something I inquire about

Customer:

fair enough, i don't like to hide things, but at the same time i don't want to be flagged as someone too nervous to perform there duties. My mother has Pakinson's, I am her main caretaker, my father suddenly died of a heart attack a few years back, and at 31 i am trying to get my foot in a good career

Dr. Z :

I do not think you have anything to be worried about regarding the medication. It is not usually a red flag at all, but I would inquire about it to ask about suicidal thoughts, current anxiety level, etc...I think you will be fine

Customer:

okay lets jump to the next drug, tylenol #4 now i got it from my doctor after injurying myself arm wrestling, now when i take it it makes me cheery, but at the same time after a few hours i think it makes me the opposite, now i'm pretty sure what your response will be but can you explain how the medication works better

Dr. Z :

Well the Tylenol is blocking pain receptors and this is why you are feeling cheery at times, but when it wears off you get a mild withdrawal effect. This is why individuals sometimes become addicted to codeine

Customer:

yeah that sounds right to me

Customer:

are some people more emotional when the first wake up, i mean my LCSW tells me to go for a jog as soon as a wake to increase endorphines and spend some spent up energy from sleeping

Customer:

they*

Dr. Z :

Yes it is possible, because your subconscious when you dream can have an effect on you as you are processing a lot of emotions and thoughts, and as soon as you wake up there is an after effect of that which is why you are emotional still

Customer:

anything i can do to reduce this?

Dr. Z :

The medication should help. But you can also try to listen to uplifting music, watch something humorous, etc... to help you dream in a more positive way

Dr. Z :

But truthfully we have not figured out an effective way to tap into the subconscious level yet in this manner

Customer:

too bad lol

Customer:

okay in all honesty since you do interviews is it better for me to admit i'm on paxil or can I keep that to myself. I feel my reasons to be on it are legit, at the same time I don't want to get that biased doctor that thinks being on it is evil

Dr. Z :

I would keep it to yourself, some doctors are not as openminded as me.

Customer:

well thank you for your honesty

Dr. Z :

Anytime :)

Customer:

you will get a good tip!

Customer:

i have to bug you one more time, this question might be hard to answer.

Dr. Z :

Thank you, XXXXX XXXXX that

Dr. Z :

Sure go for it

Customer:

I work for NJ transit, when I got hired over a year ago on the drug test paper I did put i was on paxil, now since its the same company in regards XXXXX XXXXX police dept, do you think they can ask the insurance company what drugs i'm ordering or is that protected by hippa/ada?

Dr. Z :

This is an easy question actually, no they cannot legally look back at your private medical records. You are given a new identifying number as per HIPPA law and state privacy laws.

Customer:

awesome that's a relief

Dr. Z :

No problem, I used to work in NYC and I consulted on police officer cases in NJ, so that is definitely the law in that state

Customer:

you made my night thank you! see i analyze alot! but its for good reasons

Customer:

you have a great night thank you again for your time

Dr. Z :

You have a great night as well, best of luck to you :) My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime.

I will tell you that...the things you have to go through to be an Expert are quite rigorous.

What Customers are Saying:

I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly.
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I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly.
Thank you very muchCorrie MollPretoria, South Africa

I thank-you so much! It really helped to have this information and
confirmation. We will watch her carefully and get her in for the
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well! ClaudiaAlbuquerque, NM

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Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.

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